culturally adapted psychological support for conflict-affected afghans: study protocol on mental health & violence

Conditions: Depression and Suicide Ideation; Anxiety; PTSD

Summary: this pilot study examines the feasibility and acceptability of a culturally adapted psychological intervention-problem management plus with emotional processing (pm+ ep)-for young afghans aged 16-30 experiencing high psychological distress. through a pilot randomized control trial and qualitative interviews, the study explores whether pm+ ep can reduce symptoms of anxiety, depression, ptsd, and aggression, and improve daily functioning. findings will inform the potential for a larger trial and address critical mental health and violence prevention needs in conflict-affected afghan communities.

background: a large portion of afghanistan's population, particularly children, has endured prolonged conflict, poverty, and displacement, leading to significant psychological distress. as children grow into adolescence and adulthood, this distress often manifests in mental health symptoms and an increased likelihood of violent behaviours. with limited mental health professionals and strong stigma around mental health in afghanistan, culturally adapted, evidence-based interventions are needed. objective: the study aims to explore the feasibility and acceptability of culturally adapted mental health intervention problem management plus with an additional emotional processing module (pm+ ep), in reducing psychological distress in young afghans. the primary objective is to assess the feasibility of delivering this intervention in afghanistan and its acceptability by the target communities, and the secondary objective is to assess symptom reduction and behavioural change. methods: this is a pilot randomized control trial (rct) with participants aged 16 to 30 in afghanistan. eligible participants, young afghans with high levels of distress and impaired functioning - measured by the kessler psychological distress scale (k10) -, will be randomized to pm+ ep (n=30) or the waiting group (n=30). the participants will be evaluated through self-report questionnaires at three time points; baseline (t1), four weeks later immediately post-intervention (t2), and 3 months post-intervention (t3), and through a qualitative interview (process evaluation) at the end of the study. outcomes will include measures of anxiety and depression (hscl-25), aggressive behaviours (agq), ptsd symptoms (pcl-5), and daily functioning (whodas 2.0). analysis: this study will assess the feasibility and acceptability of culturally adapted pm+ ep in afghanistan and explore the relationship between mental health symptoms and violence among young afghans. it will be the first to evaluate the feasibility of pm+ ep with this population and could pave the way for a large define rct examining the effectiveness this approach, should the results show promise.

Eligibility criteria:
inclusion criteria: * psychological distress, measured at \>15 on the kessler psychological distress scale (k10) * afghan nationality * age between 16 and 30 * ability to read and write in dari exclusion criteria: * imminent suicide risk * experiencing psychosis * neurological or cognitive disabilities

Keywords: youth mental health afghanistan implementation science culturally adapted psychological support evidence informed interventions mental health symptoms psychological experiences